Healthcare Provider Details

I. General information

NPI: 1861640633
Provider Name (Legal Business Name): LYNN M DUDEK MS,CCC-SLP, BCBA,MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 BILLINGSLEY RD
COLUMBUS OH
43235-1990
US

IV. Provider business mailing address

4415 SWENSON ST
HILLIARD OH
43026-3805
US

V. Phone/Fax

Practice location:
  • Phone: 614-470-2018
  • Fax: 614-489-6200
Mailing address:
  • Phone: 614-529-0672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 4345
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: